INTRODUCTION:

Maternal and child health are critically important in a country that is experiencing high infant mortality and maternal mortality. Realising the importance of maternal and child health services, the Ministry of Health took up step to strengthen maternal and child health services in the first and second five years plans. Reproductive and Child Health (RCH) care is an essential component of the primary health care services, and India is committed to the provision of “Health for All” through primary health care approach.

The RCH programme of the Government of India aims to effectively bring all the RCH services within easy reach of the community. The public health care delivery system in India at present has a three-tier structure. The primary tier has been developed to provide health and family welfare related services to the vast majority of rural people. It comprises three types of health care institutions: Sub-Centre, Primary Health Centre and Community Health Centre. The secondary tier, which is primary to the urban mass, includes medical care provided by the specialists at the district and sub-divisional hospitals. Tertiary health care encompasses sophisticated services provided by the super-specialists at medical colleges and specialized hospitals^{1, 2}.

Despite the gradual improvement in health status over many years, preventable mortality and morbidity in Orissa are high. The Government of Orissa has launched RCH-II programme in the State since April 2005 with goals of reducing IMR from 87 per 1,000 live births to 50 per 1000, MMR from 367/100000 to 250/100000. Component for child health has been designed as per the IMNCI protocol. Special emphasis has been made to initiate community level involvement on basic and comprehensive emergency obstetric care as regards maternal and child health. A separate component has been designed for Adolescent Reproductive Health to be implemented as a mainstream strategic component of RCH Programme. The goal of the Department of Health and Family Welfare, Government of Orissa is to facilitate the incremental improvement in the health status of people of Orissa with their participation, and to make available health care in a socially equitable, accessible and affordable manner within a reasonable timeframe, creating partnerships between public, voluntary and private health sector and across other developmental sectors³.

The Reproductive and child health programmed is an integrated and comprehensive programmer based on realistic, decentralized area specific in micro planning tailored to meet the local needs. Maternal mortality is one of the key indicators of the status of reproductive health care service delivery an utilization, but it also can be an indicator of women’s status in a society. Maternal mortality, currently and issue of concern on the international health agenda, remains one of the most important public health problems in developing counties. In Sep 2000 the members of the United Nations adopted the millennium declaration and set eight millennium development goals, one of which is reducing maternal mortality. promotion of maternal and child health has been one of the most important component of the family welfare programmer of the government of India and the National population policy-2000 reiterates the government’s commitment to the safe motherhood programmer within the wider context of reproductive health.⁴

As the national family welfare moved from target based activity to client centers, demand driven, quality service programmer, health functionaries are geared up to fulfill the aspiration of the people. Quality of maternal and child health services and client satisfaction is most vital in final outcome. Maternal and child health are critically important in a country that is experiencing high infant mortality and maternal mortality. Realizing the importance of maternal and child health services. The ministry of health took up step to strengthen maternal and child health services in the first and second five years plan [1951-56 and 1956-61].in the fifth five years plans (1974-79)it was merges with the family planning service and nutrition services. Since then the promotion of maternal and child health have become the most important aspect of family welfare programmer. The MCH services are delivered by government –run CHCs, PHCs and sub-center, government hospitals and private hospitals/clinics/nursing home ^4.

Mothers and children are considered the most vulnerable group in the community, as they are susceptible to certain health problem to which other sections of the community are not exposed. It is estimated that, there occurred 1.17iakhs annual deaths related to pregnancy and childbirth in india.⁵

Accessibility is one of the principles of “Health For ALL” stated in Alma Ata declaration on primary health care but still, due lack of universal access, equality in health status cannot be assured. Moreover, because there are other important social determinants of population health and its distribution, even with the increasing catchment of tertiary health care facilities, utilization of primary health care is low due to costs, attitude of health provider, as well as location of facilities, etc.⁶

It is also known that several factors influence the utilization of these basic health care services. There is evidence to show that the demand side barriers to access services such as tradition, lack of knowledge, and financial constrains may be as important as supply factors in deterring patient from utilization services.⁶

Utilization of RCH services by the rural community has not reached the desired level. Hence the researcher having the rural background and with his personal and professional experience geared interest towards assessing the level of satisfaction and explore the factor the influencing extent of utilization of RCH services which would help the health professional to improve the plan and provision of RCH services in the community.

OBJECTIVES

1. To assess the level of satisfaction regarding reproductive and child health services among mother attending selected primary health centre’s of Pahal, BBSR.

2. To assess the factors influencing extent of utilization of reproductive and child health service among mothers attending selected primary health centers of Pahal , BBSR.

ASSUMPTIONS:

· RCH services in PHCS are either not fully functional or available at the need of hour.

· Health professionals in PHCS usually are non receptive to the clients need.

MATERIAL AND METHODS:

A quantitative study with Descriptive design and exploratory survey approach was used in this study. The study was conducted in Pahal, Primary Health Center, BBSR which is situated near to the railway station. Data were obtained from 30 mothers of having under five children. Purposive sampling technique was used to select the sample for the study. A modified Likert scale and check list was used to assess the level of satisfaction regarding RCH services and to explore the factors influencing the utilization of RCH services.

Inclusion criteria

Mothers who are:-

o Having children below 5 years of age.

o Attending selected PHCs for services.

o Willing of participate in the study.

o Present during the period of data collection.

Tool for data collection

Consist of 2 sections

Section-A:-Demographic variable

Section B:-Modified Likert scale and Checklists to assess the level of satisfaction of RCH Services

Ethical consideration: Prior to data collection permission was obtained from the Chief medical officer of the PHC and concern was taken from the respondent.

Data analysis

Data was analyzed by using descriptive and inferential statistics.

Findings:

Figure-1: showing percentage wise distribution of Demographic variable

Percentage wise distribution of mothers according to their Demographic variables

Figure -2: Showing the level of satisfaction

LEVEL OF SATISFACTION

Table -1 Percentage wise distribution of Level of satisfaction regarding RCH services.

Sl no	Antenatal care	Highly Satisfied		Moderately Satisfied		Low Satisfied
Sl no	Antenatal care	Frequency	Percentage %	Frequency	Percentage%	Frequency	Percentage%
1	Registration of mother name	26	87	4	13	-	0
2	Physical examination	22	73	8	27	-	0
3	Laboratory examination	24	80	4	13	2	7
4	Provide tetanus toxide	27	90	3	10	-	0
5	Provide nutrition supplement	20	67	8	26	2	7
6	Periodical antenatal checkup	16	53	13	43	1	4
7	Demonstrate and education regarding antenatal exercise	4	13	22	74	4	13
8	Educations regarding antenatal care(personal hygiene, avoid smoking, adequate rest)	2	7	25	83	3	10
9	Provide home visit	23	77	1	3	6	20
	Intra natal care
1o	Care during labour	9	30	20	67	1	3
11	Available for referral system	21	70	9	30	-	0
12	Available for communication facility	19	63	10	33	1	4
13	Satisfied of behavior and care of staff	5	17	22	73	3	10
14	Care of new born after birth	3	10	27	90	-	0
	Post natal care
15	Provision of care of mother and neonate during pueriperium	8	26	22	74	-	0
16	Teaching for breast feeding	16	53	14	47	-	0
17	Provision of followed care	9	30	14	47	7	23
18	Advice for family planning service	23	77	6	20	1	3
19	Advice for post natal exercise	3	10	18	60	9	30
20	Available for ambulance service	22	73	8	27	-	0

Table -2: Percentage wise distribution of Factors influencing extent of utilization of RCH services.

Factors	Never		Sometimes		Always
Factors	Frequency	Percentage %	Frequency	Percentage%	frequency	Percentage%
Transportation facility	-	0	10	33	20	67
Appropriate referral Services	-	0	8	27	22	73
Counseling about RCH services	7	23	23	77	-	0
Availability	19	63	11	37	-	0
Accessibility	16	53	14	47	-	0
Availability of ASHA workers	12	40	18	60	-	0
Availability of Anganwadi workers	-	0	13	43	17	57
Rendering services at right place	-	0	10	33	20	67
Motivation from family member	17	57	13	43	-	0

The data presented in table-1 shows that various frequency percentage wise distribution of mothers according to their level of satisfaction. The maximum number of mother (27) i.e. 90% to are highly satisfied with administration of tetanus toxide, during pregnancy followed by early registration (26) i.e. 87%, where as very low number of mother (2) i.e. 7% highly satisfied education regarding antenatal care and the maximum number of mother (9) i.e. 30% to are low satisfied with advice for postnatal exercise followed by provision of followed care (7) i.e. 23%.

The data presented in table-2 depicts that highest 73% of mothers reported that appropriate referral service factor always influencing utilization of RCH services. Whereas 77% of mothers reported that counseling about RCH services sometimes influence the utilization of RCH services.

Table No. 3 – Association between the level of satisfaction of mothers regarding RCH services with their selected demographic variables

Variables	Chi-square value	Level of Significance
Age	0.14	Not Significant
Religion	1.25	Not Significant
Educational Status	4.49	Significant
Occupation	1.25	Not Significant
Family Income Per capita	2.29	Not Significant
Type of family	0.06	Not Significant
No of children	0.34	Not Significant

d.f = 1, (Table value= 3.84), (P > 0.05, not significant)

Table no-3: Reveals that there was not significant association was found between the level of satisfaction and the demographic variables such as age, religion, occupation, income, type of family and No. of children (P>0.05) Whereas significant association was found between level of satisfaction and educational status of the mothers (P<0.05).

RECOMMENDATION:

· A similar study with a large sample size would help to find out to better generalization and conclusion.

· The study would help the nursing personnel to impact satisfaction of mother understand benefit of reproductive and child health service.

· The study would help the nursing personnel’s to create awareness about RCH service.

· It would encouraged the nursing administer to include concept of RCH service in the curriculum and policies can be made.

CONCLUSION:

All the mothers should be aware about the RCH services and for that everybody must attend the educational programme which will help them to enhance the utilization of RCH services

REFERENCE:

1. GOI. — Bulletin on Rural Health Statistics. New Delhi: Government of India, 1997.

2. VHAI. — Report of Independent Commission on Health in India. Voluntary Health Association of India. New Delhi: VHAI, 1997.\

3. Dept of health. Govt of Odisha (2007).

4. Takkakaw AA, salprasad GY. Clint satisfaction regarding RCH service sprovider: a study from outpatient department of rural health training centre. India journal of maternal and child health. 2010; 12(03):2- 10.

5. Maternal mortality rates. [Homepage on the Internet]. 2010 April 12 [cited 2011 Nov9].Availablefrom:http://www.Guardian.co.uk/news/databiog/2010/apr/12/maternal- mortality – rates – millennium – development-goals.

6. Neelanjana P. Perceived barriers to utilization of maternal health services: qualitative insights from rural Uttar Pradesh India. [Homepage on the Internet] 2009 [cited 2011 Nov 17].Available from: http.//paa2011. Princeton. edu/mobile/abstractviewers.aspx?submissionld = 111751

Received on 21.12.2014 Modified on 07.01.2015

Int. J. Nur. Edu. and Research 3(1): Jan.-March, 2015; Page 78-82

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